Bringing together the movers and shakers
A multi-sectoral, high-level group – drawn from across government, the private sector, academia, civil society and selected development partners from the local P4H network – came together in February this year to develop their leadership skills and to work collaboratively in identifying the next steps for building universal health coverage in Zambia.
Based on the premise that achieving universal health coverage (UHC) requires not only technical expertise, but crucially political and adaptive solutions as well, the Leadership for Universal Health Coverage programme (see box) facilitates active dialogue among the movers and shakers in UHC at the country level. Its innovation lies in bringing together key individuals from a wide range of institutions involved in social health protection, building leadership skills and promoting collaborative action to get universal coverage off the drawing board and into practice.
The LUHC programme is part of the Providing for Health (P4H) global network for Social Health Protection that was launched in 2007 at the G8 summit. This partnership aims to align and coordinate the support of development partners and participating country governments, ensuring they do not exacerbate challenges – through duplication or even contradictory efforts – but instead support the development of country-led solutions. The P4H network now comprises bilateral and multilateral organisations from across the world, including the African and Asian Development Banks, the ILO, World Bank and WHO, and governments of France, Germany, Spain, Switzerland and the USA (http://p4h-network.net/).
As Michael Adelhardt, P4H Coordinator based at the World Bank says:
“The chief lesson is that you need to go beyond the technical solutions; political economy, as well as value-driven and social dimensions are critical to success […] the Leadership Programme provides the space for the right partners with enough ‘clout’ to get together to discuss critical aspects of social health protection”.
The Programme is informed by leadership theory, recognising that working towards UHC is a highly complex process which differs from place to place, as well as across time. It is crucial that solutions are country-led, and that processes are above all dynamic, responsive and interactive.
The German Federal Ministry for Economic Cooperation and Development (BMZ) commissioned the Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH to design and implement the Leadership Programme in cooperation with the World Bank. The leadership meeting in Zambia was made possible with financing from the German Government, the Swiss Development Cooperation and the European Union.
Seizing the opportunity for policy dialogue in Zambia
In February this year, the Leadership Programme supported a High Level Policy Dialogue in Zambia. Mubita Luwabelwa, Deputy Director of Planning and Budgeting in the Ministry of Health, had attended earlier workshops organized by the Programme in South Africa, Kenya and Turkey with a small team from Zambia. He was so inspired by the coaching and tools he took away with him that he asked the P4H Network to provide additional support for a follow-up meeting in Zambia for a wider leadership group – seizing the opportunity to get everyone on board at a critical juncture in Zambia’s health sector development.
The Leadership Programme took up Mubita’s suggestion, inviting senior representatives from across government, as well as health service providers, the private sector, professional associations, academia and civil society to what they called the High Level Policy Dialogue on UHC. The main focus of the meeting was the development of social health insurance for Zambia, as well as kick-starting the process of developing a Health Financing Strategy, through an inclusive and cross-sectoral process.
Looking back to the 3-day leadership meeting, both the organisers and Mubita feel that the Zambia Policy Dialogue stands out as a particular success of this innovative leadership approach.
Guidance by technical and leadership experts
International experts in leadership and social health protection were critical to the event’s success, among them Martin Kalungu-Banda, a former Special Assistant to the President of Zambia. A highly experienced facilitator, Martin had also participated in earlier leadership events and was instrumental in bringing high level stakeholders to the table, from both in and outside the health sector. Together, they worked on…
- Enhancing the understanding of leadership concepts and applying leadership skills more effectively;
- Analysis of the situation: identifying the bottlenecks and challenges for achieving UHC, particularly those relating to political and value-driven concerns;
- Strengthening joint commitment to addressing the challenges – and learning from the experience of other countries in the process;
- Agreeing on the intermediate small steps, which together will achieve real progress.
Total immersion is key
Total immersion is key to the success of the leadership meetings. With this in mind, the group of leaders spent 3 days together at a lodge, away from the stresses and strains of their busy working lives. Participants were able to focus on the issues at hand, building on a shared commitment to improving healthcare delivery and access in their country, and planning the next steps towards improved social health protection for all Zambians.
Through a series of guided exercises, the participants were encouraged to use their creativity to explore the current healthcare situation in Zambia, understand the challenges, and identify ‘leverage points’ where actions could make a real difference – this is called system sculpting. System sculpting allows the group members to step back from the usual technical analysis frameworks and to look at the health system from different perspectives, including those of patients as they try navigate the different pathways to care.
Tipping the balance and achieving progress
These entry points for action were grouped with other similar actions, prioritised, and the six most important were selected. The participants then worked in groups to identify the small steps needed to move each process forward, the idea being that together, many small actions will tip the balance and lead to progress. The leverage point scoring the most votes was to “get the president to champion the UHC agenda” – recognising the importance of high level political support. Since the meeting, the President of Zambia, His Excellency Edgar Chagwa Lungu, has publicly voiced his support for Social Health Insurance on several occasions.
Other identified priorities were ‘more money for health’ – increasing the financial and fiscal allocations to the health sector, getting the whole country on board with the UHC process through better communications, increasing human resources for health, improving the quality of care and enhancing inter-ministerial collaboration. Quite a wish list!
A change in thinking
When asked about the highlights of the meeting, Michael Adelhardt said he detected a new openness and a preparedness to approach policy constraints from a different perspective. The Policy Dialogue was punctuated by those special “Aha, OK!” moments which often signal real breakthroughs in thinking.
Marielle Goursat of the Zambia ILO office, who is also the P4H Focal Point for Zambia, pointed to a greater participation in meetings that focus on social health protection.
“…I take that enhanced participation as a direct outcome of the leadership intervention”, Marielle stated.
Marielle also emphasised the high level of trust which the meeting engendered, as well as the many concrete examples of good practice provided by the external experts which could be tailored to the Zambian context. In fact, as a follow-up Marielle is organising for a team from Tanzania to visit Zambia to share their experiences in developing the Tanzanian health financing strategy.
More recently, Marielle and others working in social protection have made significant progress in organising a Social Protection Week for Zambia; a development which she cites as a further indirect impact of the policy dialogue. The theme for the week is How to make SHI work for All.
The current priorities
Right now, the most pressing need is to develop an effective Health Financing Strategy in time for the next Health Sector Strategic Plan (2017 – 2021). This will provide the policy framework for financing the expansion in health coverage which Zambia seeks to provide. Over the next three years, the P4H partnership (see text box) will provide technical support to the Ministry of Health, and the Leadership Programme is there to provide complementary support when requested by the stakeholders.
A lot is happening in Zambia to take the UHC process forward, the momentum is being maintained, and the Policy Dialogue has proved to be an excellent staging post on the long and complex road to universal coverage.
Corinne Grainger, May 2016